eMedicine Specialties > Pediatrics: Surgery > Urology

Enuresis: Differential Diagnoses & Workup

Author: Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg), Medical Director, The Children's Clinic
Contributor Information and Disclosures

Updated: Aug 31, 2009

Differential Diagnoses

Other Problems to Be Considered

See Causes.

Workup

Laboratory Studies

  • Urinalysis
    • Urinalysis is the most important screening test in a child with enuresis.
    • Children with cystitis usually have WBCs or bacteria evident in the microscopic urinalysis.
    • Children with overactive bladder or dysfunctional voiding, urethral obstruction, neurogenic bladder, ectopic ureter, or diabetes mellitus are predisposed to cystitis.
    • If the urinalysis findings suggest cystitis, urine should be sent for culture and sensitivity.
    • Urethral obstruction may be associated with RBCs in the urine.
    • The presence of glucose suggests diabetes mellitus.
    • A random or first-morning specific gravity greater than 1.020 excludes diabetes insipidus.
  • Blood tests: These are usually not needed, unless some other condition is suspected.

Imaging Studies

No imaging is needed if PE is suspected. However, if other conditions are considered, then radiologic evaluation might be warranted. Some of the testing might involve the following:

  • Ultrasonography of the kidneys and bladder (prevoiding and postvoiding)
    • Failure to empty the bladder is a significant risk factor for cystitis and is common in patients with overactive bladder, dysfunctional voiding, neurogenic bladder, and urethral obstruction. Portable bladder ultrasonography is available to assess residual urine when the patient is in the office. The residual volume of urine is normally less than 5 mL.
    • Diagnostic imaging studies are not routinely indicated; however, patients with coincidental daytime voiding symptoms should undergo ultrasonography of the bladder and kidneys. In patients with significant daytime symptoms in whom the ultrasonography result is normal, more invasive investigations should be deferred pending a 3-month period during which the voiding routine and emptying are improved, cystitis is treated or prevented, and constipation is treated.
  • Voiding cystourethrography
    • If the bladder wall is thickened or trabeculated or a significant postvoid residual volume of urine is noted, consider performing voiding cystourethrography (VCUG).
    • Perform VCUG for patients in whom a neurogenic bladder is suspected.
      • The lumbosacral spine should be visualized during the VCUG to look for sacral agenesis or spinal dysraphism.
      • The classic radiologic feature of a neurogenic bladder is a trabeculated bladder with a Christmas tree or pine cone configuration.
    • If urethral obstruction is suspected based on an abnormal urinary stream or ultrasonography findings, VCUG should be performed.
  • Urodynamic studies and cytoscopy
    • Urodynamic studies help to clarify the diagnosis of neurogenic bladder.
    • A video urodynamic study measures filling phase parameters, such as bladder capacity, presence or absence of unstable detrusor contractions, bladder compliance, and the state of the bladder neck, and voiding phase parameters, such as voiding pressures, bladder emptying, and the state of the external urethral sphincter.
    • Urodynamic studies and cystoscopy should be reserved for patients with urethral obstruction and neurogenic bladder and for patients with dysfunctional voiding who do not improve after 3 months of therapy.
  • MRI
    • MRI of the spine is indicated in any patient with an abnormal neurologic examination finding of the lower extremities; a visible defect in the lumbosacral spine; or the triad of encopresis, gait abnormality, and daytime symptoms.
    • Consider MRI in patients with significant daytime voiding dysfunction that does not improve with treatment, even if neurologic and orthopedic examination findings are normal.
  • Radiography: If OSA is suspected, consider lateral radiography of the neck or referral to a pediatric otolaryngologist for direct visualization of the nasopharynx; also consider referral to a pediatric sleep specialist.

Other Tests

  • Uroflowmetry
    • Uroflowmetry is a simple, noninvasive measurement of urine flow that is helpful to screen patients for neurogenic bladder and urethral obstruction.
    • Children are instructed to void into a special toilet with a pressure-sensitive device at the base. A normal uroflow study shows a single bell-shaped curve with a normal peak and average flow rate for age and size.
    • Patients with dysfunctional voiding, urethral obstruction, or neurogenic bladder have prolonged curves or an interrupted series of curves and low peak and average urine flow rates.

More on Enuresis

Overview: Enuresis
Differential Diagnoses & Workup: Enuresis
Treatment & Medication: Enuresis
Follow-up: Enuresis
References
Further Reading
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References

  1. Moffatt ME. Nocturnal enuresis: psychologic implications of treatment and nontreatment. J Pediatr. Apr 1989;114(4 Pt 2):697-704. [Medline].

  2. von Gontard A, Eiberg H, Hollmann E, et al. Molecular genetics of nocturnal enuresis: linkage to a locus on chromosome 22. Scand J Urol Nephrol Suppl. 1999;202:76-80. [Medline].

  3. Arnell H, Hjalmas K, Jagervall M, et al. The genetics of primary nocturnal enuresis: inheritance and suggestion of a second major gene on chromosome 12q. J Med Genet. May 1997;34(5):360-5. [Medline].

  4. Fergusson DM, Horwood LJ, Shannon FT. Secondary enuresis in a birth cohort of New Zealand children. Paediatr Perinat Epidemiol. Jan 1990;4(1):53-63. [Medline].

  5. Norgaard JP, Pedersen EB, Djurhuus JC. Diurnal anti-diuretic-hormone levels in enuretics. J Urol. Nov 1985;134(5):1029-31. [Medline].

  6. Rittig S, Knudsen UB, Norgaard JP, et al. Diurnal variation of plasma atrial natriuretic peptide in normals and patients with enuresis nocturna. Scand J Clin Lab Invest. Apr 1991;51(2):209-17. [Medline].

  7. Mattsson S, Lindstrom S. Diuresis and voiding pattern in healthy schoolchildren. Br J Urol. Dec 1995;76(6):783-9. [Medline].

  8. Bloom DA, Seeley WW, Ritchey ML, McGuire EJ. Toilet habits and continence in children: an opportunity sampling in search of normal parameters [published erratum appears in J Urol 1993 Dec;150(6):1924]. J Urol. May 1993;149(5):1087-90. [Medline].

  9. von Gontard A, Mauer-Mucke K, Pluck J, et al. Clinical behavioral problems in day- and night-wetting children. Pediatr Nephrol. Oct 1999;13(8):662-7. [Medline].

  10. Berul CI, Murphy JD. Nocturnal enuresis secondary to heart block: report of cure by cardiac pacemaker implantation. Pediatrics. Aug 1993;92(2):284-5. [Medline].

  11. Kozeny GA, Wood WS. Secondary enuresis associated with hyperthyroidism. J Fam Pract. Sep 1986;23(3):273-4. [Medline].

  12. Forsythe WI, Butler RJ. Fifty years of enuretic alarms. Arch Dis Child. Jun 1989;64(6):879-85. [Medline].

  13. Aladjem M, Wohl R, Boichis H, et al. Desmopressin in nocturnal enuresis. Arch Dis Child. Feb 1982;57(2):137-40. [Medline].

  14. Arikan N, Soygur T, Selcuki M, et al. Role of magnetic resonance imaging in children with voiding dysfunction: retrospective analysis of 81 patients. Urology. Jul 1999;54(1):157-60; discussion 160-1. [Medline].

  15. Bachelard M, Sillen U, Hansson S, et al. Urodynamic pattern in infants with urinary tract infection. J Urol. Aug 1998;160(2):522-6. [Medline].

  16. Bakwin H. Enuresis in children. J Pediatr. Jun 1961;58:806-19. [Medline].

  17. Bakwin H. Enuresis in twins. Am J Dis Child. Mar 1971;121(3):222-5. [Medline].

  18. Barkai L, Szabo L. Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy. Eur J Pediatr. Mar 1993;152(3):190-2. [Medline].

  19. Bloom DA, Faerber G, Bomalaski MD. Urinary incontinence in girls. Evaluation, treatment, and its place in the standard model of voiding dysfunctions in children. Urol Clin North Am. Aug 1995;22(3):521-38. [Medline].

  20. Bloom DA, Park JM, Koo HP. Comments on pediatric elimination dysfunctions: the Whorf hypothesis, the elimination interview, the guarding reflex and nocturnal enuresis. Eur Urol. 1998;33 Suppl 3:20-4. [Medline].

  21. Boemers TM, van Gool JD, de Jong TP, Bax KM. Urodynamic evaluation of children with the caudal regression syndrome (caudal dysplasia sequence). J Urol. Apr 1994;151(4):1038-40. [Medline].

  22. Bonde HV, Andersen JP, Rosenkilde P. Nocturnal enuresis: change of nocturnal voiding pattern during alarm treatment. Scand J Urol Nephrol. Dec 1994;28(4):349-52. [Medline].

  23. Bradbury M. Combination therapy for nocturnal enuresis with desmopressin and an alarm device. Scand J Urol Nephrol Suppl. 1997;183:61-3. [Medline].

  24. Brazelton TB. A child-oriented approach to toilet training. Pediatrics. Jan 1962;29:121-8. [Medline].

  25. Byrd RS, Weitzman M, Lanphear NE, Auinger P. Bed-wetting in US children: epidemiology and related behavior problems. Pediatrics. Sep 1996;98(3 Pt 1):414-9. [Medline].

  26. Carroll JL, Loughlin GM. Diagnostic criteria for obstructive sleep apnea syndrome in children. Pediatr Pulmonol. Oct 1992;14(2):71-4. [Medline].

  27. Chai TC. This month in investigative urology: new insights into the clinical value of oxybutynin. J Urol. Sep 1998;160(3 Pt 1):644. [Medline].

  28. de Graaf MJ. 40 years of being treated for nocturnal enuresis. Lancet. Oct 17 1992;340(8825):957-8. [Medline].

  29. DiMichele S, Sillen U, Engel JA, et al. Desmopressin and vasopressin increase locomotor activity in the rat via a central mechanism: implications for nocturnal enuresis. J Urol. Sep 1996;156(3):1164-8. [Medline].

  30. Dohil R, Roberts E, Jones KV, Jenkins HR. Constipation and reversible urinary tract abnormalities. Arch Dis Child. Jan 1994;70(1):56-7. [Medline].

  31. Eggert P, Kuhn B. Antidiuretic hormone regulation in patients with primary nocturnal enuresis. Arch Dis Child. Dec 1995;73(6):508-11. [Medline].

  32. Eiberg H, Berendt I, Mohr J. Assignment of dominant inherited nocturnal enuresis (ENUR1) to chromosome 13q. Nat Genet. Jul 1995;10(3):354-6. [Medline].

  33. Evans JH, Meadow SR. Desmopressin for bed-wetting: length of treatment, vasopressin secretion, and response. Arch Dis Child. Feb 1992;67(2):184-8. [Medline].

  34. Feehan M, McGee R, Stanton W, Silva PA. A 6 year follow-up of childhood enuresis: prevalence in adolescence and consequences for mental health. J Paediatr Child Health. Apr 1990;26(2):75-9. [Medline].

  35. Fernandes E, Vernier R, Gonzalez R. The unstable bladder in children. J Pediatr. Jun 1991;118(6):831-7. [Medline].

  36. Fernandes ET, Reinberg Y, Vernier R, Gonzalez R. Neurogenic bladder dysfunction in children: review of pathophysiology and current management. J Pediatr. Jan 1994;124(1):1-7. [Medline].

  37. Fjellestad-Paulsen A, Wille S, Harris AS. Comparison of intranasal and oral desmopressin for nocturnal enuresis. Arch Dis Child. Jul 1987;62(7):674-7. [Medline].

  38. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuresis. Arch Dis Child. Apr 1974;49(4):259-63. [Medline].

  39. Frary LG. Nocturnal enuresis: A genetic study. Arch Pediatr Adolesc Med. 1935;49:557-78.

  40. Friedell A. A reversal of the normal concentration of the urine in children having nocturnal enuresis. Arch Pediatr Adolesc Med. 1927;33:717-21.

  41. Friman PC, Handwerk ML, Swearer SM, et al. Do children with primary nocturnal enuresis have clinically significant behavior problems?. Arch Pediatr Adolesc Med. Jun 1998;152(6):537-9. [Medline].

  42. [Guideline] Fritz G, Rockney R, Bernet W, Arnold V, Beitchman J, Benson RS, et al. Practice parameter for the assessment and treatment of children and adolescents with enuresis. J Am Acad Child Adolesc Psychiatry. Dec 2004;43(12):1540-50. [Medline].

  43. George CP, Messerli FH, Genest J, et al. Diurnal variation of plasma vasopressin in man. J Clin Endocrinol Metab. Aug 1975;41(2):332-8. [Medline].

  44. Gutierrez Segura C. Urine flow in childhood: a study of flow chart parameters based on 1,361 uroflowmetry tests. J Urol. Apr 1997;157(4):1426-8. [Medline].

  45. Hagglof B, Andren O, Bergstrom E, et al. Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence. Scand J Urol Nephrol Suppl. 1997;183:79-82. [Medline].

  46. Hallgren B. Enuresis: a clinical and genetic study. Acta Psychiatr Neurol Scand. 1957;32(Suppl 114):1-159. [Medline].

  47. Haque M, Ellerstein NS, Gundy JH, et al. Parental perceptions of enuresis. A collaborative study. Am J Dis Child. Sep 1981;135(9):809-11. [Medline].

  48. Hellstrom A, Hanson E, Hansson S, et al. Micturition habits and incontinence at age 17--reinvestigation of a cohort studied at age 7. Br J Urol. Aug 1995;76(2):231-4. [Medline].

  49. Hjalmas K. Urodynamics in normal infants and children. Scand J Urol Nephrol Suppl. 1988;114:20-7. [Medline].

  50. Hjalmas K, Arnold T, Bower W, et al. Nocturnal enuresis: an international evidence based management strategy. J Urol. Jun 2004;171(6 Pt 2):2545-61. [Medline].

  51. Hollmann E, Von Gontard A, Eiberg H, et al. Molecular genetic, clinical and psychiatric associations in nocturnal enuresis. Br J Urol. May 1998;81 Suppl 3:37-9. [Medline].

  52. Holmdahl G, Hanson E, Hanson M, et al. Four-hour voiding observation in healthy infants. J Urol. Nov 1996;156(5):1809-12. [Medline].

  53. Jarvelin MR, Moilanen I, Kangas P, et al. Aetiological and precipitating factors for childhood enuresis. Acta Paediatr Scand. Mar 1991;80(3):361-9. [Medline].

  54. Kawauchi A, Imada N, Tanaka Y, et al. Changes in the structure of sleep spindles and delta waves on electroencephalography in patients with nocturnal enuresis. Br J Urol. May 1998;81 Suppl 3:72-5. [Medline].

  55. Kawauchi A, Watanabe H, Miyoshi K. Early morning urine osmolality in nonenuretic and enuretic children. Pediatr Nephrol. Dec 1996;10(6):696-8. [Medline].

  56. Kawauchi A, Yamao Y, Nakanishi H, et al. Relationships among nocturnal urinary volume, bladder capacity, and nocturia with and without water load in nonenuretic children. Urology. Mar 2002;59(3):433-7. [Medline].

  57. Key DW, Bloom DA, Sanvordenker J. Low-dose DDAVP in nocturnal enuresis. Clin Pediatr (Phila). May 1992;31(5):299-301. [Medline].

  58. Kriss VM, Kriss TC, Desai NS, Warf BC. Occult spinal dysraphism in the infant. Clin Pediatr (Phila). Dec 1995;34(12):650-4. [Medline].

  59. Liddell HG, Scott RA, eds. Greek-English Lexicon. Oxford, England: The Clarendon Press;1953.

  60. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. Aug 1997;100(2 Pt 1):228-32. [Medline]. [Full Text].

  61. Longstaffe S, Moffatt ME, Whalen JC. Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics. Apr 2000;105(4 Pt 2):935-40. [Medline]. [Full Text].

  62. Malone PS, Wheeler RA, Williams JE. Continence in patients with spina bifida: long-term results. Arch Dis Child. Feb 1994;70(2):107-10. [Medline].

  63. McGee R, Makinson T, Williams S, et al. A longitudinal study of enuresis from five to nine years. Aust Paediatr J. Mar 1984;20(1):39-42. [Medline].

  64. Medel R, Dieguez S, Brindo M, et al. Monosymptomatic primary enuresis: differences between patients responding or not responding to oral desmopressin. Br J Urol. May 1998;81 Suppl 3:46-9. [Medline].

  65. Medel R, Ruarte AC, Castera R, Podesta ML. Primary enuresis: a urodynamic evaluation. Br J Urol. May 1998;81 Suppl 3:50-2. [Medline].

  66. Miller K, Goldberg S, Atkin B. Nocturnal enuresis: experience with long-term use of intranasally administered desmopressin. J Pediatr. Apr 1989;114(4 Pt 2):723-6. [Medline].

  67. Misra D, Mushtaq I, Drake DP, et al. Associated urologic anomalies in low imperforate anus are capable of causing significant morbidity: a 15-year experience. Urology. Aug 1996;48(2):281-3. [Medline].

  68. Moffatt ME, Harlos S, Kirshen AJ, Burd L. Desmopressin acetate and nocturnal enuresis: how much do we know?. Pediatrics. Sep 1993;92(3):420-5. [Medline].

  69. Morison MJ. Parents' and young people's attitudes towards bedwetting and their influence on behaviour, including readiness to engage in and persist with treatment. Br J Urol. May 1998;81 Suppl 3:56-66. [Medline].

  70. Mowrer OH, Mowrer WM. Nocturnal enuresis - a method for its study and treatment. Am J Orthopsychiatry. 1938;8:436-59.

  71. Neveus T, Lackgren G, Stenberg A, et al. Sleep and nighttime behaviour of enuretics and non-enuretics. Br J Urol. May 1998;81 Suppl 3:67-71. [Medline].

  72. Neveus T, Lackgren G, Tuvemo T, et al. Enuresis--background and treatment. Scand J Urol Nephrol Suppl. 2000;206:1-44. [Medline].

  73. Neveus T, Tuvemo T, Lackgren G, Stenburg A. Bladder capacity and renal concentrating ability in enuresis: pathogenic implications. J Urol. Jun 2001;165(6 Pt 1):2022-5. [Medline].

  74. Norgaard JP, Djurhuus JC, Watanabe H, et al. Experience and current status of research into the pathophysiology of nocturnal enuresis. Br J Urol. Jun 1997;79(6):825-35. [Medline].

  75. Norgaard JP, Hansen JH, Nielsen JB, et al. Nocturnal studies in enuretics. A polygraphic study of sleep-EEG and bladder activity. Scand J Urol Nephrol Suppl. 1989;125:73-8. [Medline].

  76. Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom AL. Standardization and definitions in lower urinary tract dysfunction in children. International Children's Continence Society. Br J Urol. May 1998;81 Suppl 3:1-16. [Medline].

  77. Nowak KC, Weider DJ. Pediatric nocturnal enuresis secondary to airway obstruction from cleft palate repair. Clin Pediatr (Phila). Nov 1998;37(11):653-7. [Medline].

  78. O'Regan S, Yazbeck S, Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. Mar 1985;23(3):152-4. [Medline].

  79. Ohne T. The increase in C-fos expression in vasopressin and oxytocin immunoreactive neurons in the paraventricular and supraoptic nucleus of the hypothalamus following urinary retention. J Kyoto Pref Univ Med. 1995;104:393-403.

  80. Oredsson AF, Jorgensen TM. Changes in nocturnal bladder capacity during treatment with the bell and pad for monosymptomatic nocturnal enuresis. J Urol. Jul 1998;160(1):166-9. [Medline].

  81. Page ME, Akaoka H, Aston-Jones G, Valentino RJ. Bladder distention activates noradrenergic locus ceruleus neurons by an excitatory amino acid mechanism. Neuroscience. Dec 1992;51(3):555-63. [Medline].

  82. Park JM, Bloom DA, McGuire EJ. The guarding reflex revisited. Br J Urol. Dec 1997;80(6):940-5. [Medline].

  83. Poulton EM. Relative nocturnal polyuria as a factor in enuresis. Lancet. Nov 8 1952;2(19):906-7. [Medline].

  84. Ramsden PD, Hindmarsh JR, Price DA, et al. DDAVP for adult enuresis--a preliminary report. Br J Urol. Jun 1982;54(3):256-8. [Medline].

  85. Reid CJ, Borzyskowski M. Lower urinary tract dysfunction in cerebral palsy. Arch Dis Child. Jun 1993;68(6):739-42. [Medline].

  86. Richardson MA, Seid AB, Cotton RT, et al. Evaluation of tonsils and adenoids in Sleep Apnea syndrome. Laryngoscope. Jul 1980;90(7 Pt 1):1106-10. [Medline].

  87. Rittig S, Knudsen UB, Norgaard JP, et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. Apr 1989;256(4 Pt 2):F664-71. [Medline].

  88. Robson LM, Leung AK. Urotherapy recommendations for bedwetting. J Natl Med Assoc. Jul 2002;94(7):577-80. [Medline].

  89. Robson WL. Diurnal enuresis. Pediatr Rev. Dec 1997;18(12):407-12; quiz 412. [Medline].

  90. Robson WL. Enuresis treatment in the US. Scand J Urol Nephrol Suppl. 1999;202:56-60. [Medline].

  91. Robson WL. Enuresis. Adv Pediatr. 2001;48:409-38. [Medline].

  92. Robson WL, Leung AK. Intranasal desmopressin (DDAVP) in the treatment of nocturnal enuresis. A review of efficacy studies. Today's Ther Trends. 1993;2:35-42.

  93. Robson WL, Leung AK. Secondary nocturnal enuresis. Clin Pediatr (Phila). Jul 2000;39(7):379-85. [Medline].

  94. Robson WL, Leung AK. Side effects and complications of treatment with desmopressin for enuresis. J Natl Med Assoc. Oct 1994;86(10):775-8. [Medline].

  95. Robson WL, Leung AK. Side effects associated with DDAVP treatment of nocturnal enuresis. J Singapore Paediatr Soc. 1994;36:81-4.

  96. Robson WL, Leung AK, Brant R. The genetic influence in primary nocturnal enuresis. Nocturnal Enuresis. 1992;2:4-6.

  97. Robson WL, Leung AK, Van Howe R. Primary and secondary nocturnal enuresis: similarities in presentation. Pediatrics. Apr 2005;115(4):956-9. [Medline].

  98. Robson WL, Norgaard JP, Leung AK. Hyponatremia in patients with nocturnal enuresis treated with DDAVP. Eur J Pediatr. Nov 1996;155(11):959-62. [Medline].

  99. Rocklin N, Tilker H. Instrumental conditioning of nocturnal enuresis: A reappraisal of some previous findings. Proc Am Psychol Assoc. 1973;915-6.

  100. Rushton HG. Older pharmacologic therapy for nocturnal enuresis. Clin Pediatr (Phila). Jul 1993;Spec No:10-3. [Medline].

  101. Schaumburg HL, Hunsballe JM, Rittig S, et al. The effect of the full bladder on vasopressin secretion in healthy young adults. Scand J Urol Nephrol Suppl. 1997;183:29-30. [Medline].

  102. Skoog SJ, Stokes A, Turner KL. Oral desmopressin: a randomized double-blind placebo controlled study of effectiveness in children with primary nocturnal enuresis. J Urol. Sep 1997;158(3 Pt 2):1035-40. [Medline].

  103. Soler D, Borzyskowski M. Lower urinary tract dysfunction in children with central nervous system tumours. Arch Dis Child. Oct 1998;79(4):344-7. [Medline]. [Full Text].

  104. Steers WD, Suratt PM. Sleep apnea as a cause of daytime and nocturnal enuresis. Lancet. May 31 1997;349(9065):1604. [Medline].

  105. Steffens J, Netzer M, Isenberg E, et al. Vasopressin deficiency in primary nocturnal enuresis. Results of a controlled prospective study. Eur Urol. 1993;24(3):366-70. [Medline].

  106. Sukhai RN, Mol J, Harris AS. Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis. Eur J Pediatr. Feb 1989;148(5):465-7. [Medline].

  107. Tuvemo T. DDAVP in childhood nocturnal enuresis. Acta Paediatr Scand. Nov 1978;67(6):753-5. [Medline].

  108. van Gool JD, de Jonge GA. Urge syndrome and urge incontinence. Arch Dis Child. Nov 1989;64(11):1629-34. [Medline].

  109. Van Tijen NM, Messer AP, Namdar Z. Perceived stress of nocturnal enuresis in childhood. Br J Urol. May 1998;81 Suppl 3:98-9. [Medline].

  110. Vande Walle J, Hoebeke P, Van Laecke E, et al. Persistent enuresis caused by nocturnal polyuria is a maturation defect of the nyctihemeral rhythm of diuresis. Br J Urol. May 1998;81 Suppl 3:40-5. [Medline].

  111. von Gontard A, Hollmann E, Eiberg H, et al. Clinical enuresis phenotypes in familial nocturnal enuresis. Scand J Urol Nephrol Suppl. 1997;183:11-6. [Medline].

  112. Vulliamy D. The day and night output of urine in enuresis. Arch Dis Child. Dec 1956;31(160):439-43. [Medline].

  113. Vurgun N, Yiditodlu MR, Ypcan A, et al. Hypernatriuria and kaliuresis in enuretic children and the diurnal variation. J Urol. Apr 1998;159(4):1333-7. [Medline].

  114. Warzak WJ. Psychosocial implications of nocturnal enuresis. Clin Pediatr (Phila). Jul 1993;Spec No:38-40. [Medline].

  115. Watanabe H. Sleep patterns in children with nocturnal enuresis. Scand J Urol Nephrol Suppl. 1995;173:55-6; discussion 56-7. [Medline].

  116. Watanabe H, Azuma Y. A proposal for a classification system of enuresis based on overnight simultaneous monitoring of electroencephalography and cystometry. Sleep. Jun 1989;12(3):257-64. [Medline].

  117. Wolfish NM. Sleeping patterns and their effects on the etiology and treatment of nocturnal enuresis. Nocturnal Enuresis. 1996;5:4-5.

  118. Yeung CK, Sit FK, To LK, et al. Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int. Aug 2002;90(3):302-7. [Medline].

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Keywords

enuresis, bedwetting, bed-wetting, nocturnal enuresis, NE, primary nocturnal enuresis, PNE, secondary nocturnal enuresis SNE, nocturia, voiding dysfunction, incontinence, overactive bladder, urge syndrome, dysfunctional voiding, cystitis, constipation, neurogenic bladder

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Contributor Information and Disclosures

Author

Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg), Medical Director, The Children's Clinic
Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg) is a member of the following medical societies: International Children's Continence Society, Royal College of Physicians and Surgeons of Canada, and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.

Medical Editor

Howard M Snyder III, MD, Professor, Department of Surgery, Division of Pediatric Urology, University of Pennsylvania School of Medicine
Howard M Snyder III, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

 
 
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